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jueves, 20 de diciembre de 2012

ARDS

Acute respiratory distress syndrome and acute lung injury

Dushianthan A., Grocott W., Postle A., Cusak R.

Postgrad Med J. 2011; 87: 612-622

ABSTRACT: "Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Several aetiological factors associated with the development of ARDS are identified with sepsis, pneumonia, and trauma with multiple transfusions accounting for most cases. Despite the absence of a robust diagnostic definition, extensive epidemiological investigations suggest ARDS remains a significant health burden with substantial morbidity and mortality. Improvements in outcome following ARDS over the past decade are in part due to improved strategies of mechanical ventilation and advanced support of other failing organs. Optimal treatment involves judicious fluid management, protective lung ventilation with low tidal volumes and moderate positive end expiratory pressure, multi-organ support, and treatment where possible of the underlying cause..."

"A consensus panel led by V. Marco Ranieri, Gordon Rubenfeld, Arthur Slutsky et al announced a new definition and severity classfication system for acute respiratory distress syndrome (ARDS)that aims to simplify the diagnosis and better prognosticate outcomes from the life-threatening pulmonary illness.

The proposed “Berlin definition” predicted mortality ever-so-slightly better than the existing definition (created at the 1994 American-European Consensus Conference/AECC), when applied to a cohort of 4,400 patients from past randomized trials."